Why Do Black Men Live Longer in Prison?

(Comstock)

A recent Reuters headline got a lot of attention on the Web. It read: “Black men survive longer in prison than out: study.” Gawker picked it up; so did The Atlantic, Yahoo, and the Grio. I tracked down the study’s author David Rosen, an epidemiology PhD and a post-doctoral fellow at the University of North Carolina, to see if this was actually the case. Rosen focuses his research on the health-care system inside prisons. For this latest study, he matched North Carolina prison records against state death records from 1995 to 2005, in order to compare the mortality rates of black and white male prisoners against their general population counterparts.
The results of his sample (100,000 men aged 20-79) were striking in how much they differed by race. While the total death rate of black men in prison is half that of black men in the general population, white prisoners die at about a 12% faster clip than their general population counterparts. This is essentially what a previous report by the U.S. Bureau of Justice Statistics found in 2007.
Rosen was good enough to answer questions about what he feels his study says about health-care, prisons and race.
Q: Have you been surprised by the attention your study has gotten?
A: Yes, although some of that attention has been misplaced. Some people have implied that our results suggest that black men in particular would be better off in prison, which is not only a ludicrous and offensive sentiment, but it’s also misinformed. Lower mortality rates in prison are not exclusive to black men. There have been studies in England, France, and Russia that show similar mortality results for a variety of populations, where the mortality rate is lower in prison than out. Also, our earlier study from 2008 found that the mortality rate of white men released from prison was twice that of general population white men; in light of our recent results, this suggests that mortality among white prisoners is also lower when they are in prison than after they have returned to the community. The majority of people in prison are young men. In the community, young men are at greater risk of death from accidents and traumatic injuries. While prison has its own risks, overall the risks common in the community seem to be reduced to a degree in prison. And that’s true for all men, not just black men.
Q: OK, but the results of this data are pretty stark. Clearly there’s a racial difference.
A: Actually, we found that mortality rates among black and white male prisoners were similar across each age group. It’s when we compare mortality rates between prisoners and community men by race that we see differences, and those differences reflect the fact that mortality among blacks in the general population is higher than for whites. These health disparities across races in the community have been around for a long time, and our results remind us that we still have more work to do to resolve them. I think that’s one of the biggest issues these results bring to light.
Q: So then what does this say about white prisoners? Why are they dying at a rate faster than expected?
A: Mortality rates among white men in prison are slightly greater than white men in the community. It’s not clear why, but these findings ultimately relate to how sick prisoners were when they entered prison, the prison environment, and their access to healthcare in prison.
Q: What do you think this says about the prison health-care system?
A: There is something about the prison system that’s impacting health. People are getting doctor’s checkups and dental care, there is a greater intensity of care going on than perhaps they’re getting on the outside.  But without data on how sick prisoners are when they come into prison, it’s difficult to disentangle the effect of healthcare and simply having access to basic resources in prison. Of course both these factors have an influence on prisoners’ health. It’s also important to remember, 95% of prisoners are released within a year or two, so the larger story is what happens to those released prisoners. We think of the prison population and the rest of the population as distinct, but they’re not. Each year some 700,000 inmates are released from state prisons. Their health has an impact on the health of their communities. And a large percentage of the prison population probably isn’t getting the care they need when they are out in the community.